2
Lisa Hayes, M.B.A.
Has no real or apparent conflicts of interest to report.
Conflict of Interest
3
• Who is Chatham County Safety Net Planning Council (Safety Net)
• ChathamHealthLink (CHL) and interconnecting with the Georgia
Regional Academic Community Health Information Exchange
(GRAChIE)
• CHL/GRAChIE, improving continuity of care for vulnerable
populations
• Connecting the Chatham County Detention Center
• Measuring “Continuity of Care” through crossover data
• Jail Heath Care Provider Accountability
• Recommendations
Agenda
4
• Assess project readiness, local resources and political will
necessary to connect a county jail to a Health Information
Exchange (HIE)
• Design a process to onboard a county jail to a local HIE and
assess possible barriers
• Design meaningful accountability structure and performance
measurements to ensure accountability for healthcare vendor and
decrease liability for local governments
Learning Objectives
5
• Key Partners:
– Memorial University Medical Center
– St. Joseph’s/Candler Health Systems (SJ/C)
– SJ/C St. Mary’s Health Center, Good Samaritan
Community clinic, St. Mary’s Community Center
– Curtis V. Cooper Primary Health Care, Inc.
– J.C. Lewis Primary Health Care Center
– Gateway Community Service Board
– Coastal Health District
• Key Programs:
– Evaluation
– Health Information Exchange
– Homeless Health Care Delivery
– Children’s Health Insurance
– Behavioral Health Capacity Building
– Community Suicide Awareness & Prevention
– Community Information Exchange
Mission:
The mission of Chatham County Safety Net Planning Council (Safety Net) is
to develop an infrastructure to maximize access and utilization of affordable
health services and to leverage available resources to assure improved
health status for our Chatham County residents.
6
ChathamHealthLink(CHL)
A History from 2005 to present
Merger:
Interconnecio
n with
GRAChIE
8
• Founding Principle and Focus – Care Coordination
• Membership across the state of Georgia includes
– 2.5 million unique patients
– 14 Hospitals systems
– 199 Independent Physician Practices
– FQHCs
– Correctional healthcare
– Long-term care
• Centralized HIE with external partner connections – eHealth
Exchange (VA & DOD), partners in neighboring states.
• Data elements available in GRAChIE adhere to CCD and/or CCDA
standards, plus ADTs and clinical documentation via ORU
GRAChIE
Who is Georgia Regional Academic Community
Health Information Exchange (GRAChIE)?
9
ChathamHealthLink/GRAChIE today
ChathamHealthLink
Members:
Memorial Health University Medical
Center
Curtis V. Cooper Primary Health
Care, Inc.
J. C. Lewis Primary Health Care
Center, Inc.
Chatham CARE Ryan White Center
Gateway Community Service Board
(GAIT Consortium)
Chatham County Detention Center
Community Health Mission (historical
data)
Non CHL local GRAChIE
members:
Chatham Ortho
ENT Consultants of Savannah
Gastroenterology Consultants of
Savannah
Nephrology and Hypertension
Medical Associates
Pediatric Associates of Savannah
Savannah Cardiology
Savannah Vascular
SouthCoast Medical
Southeast Lung
GRAChIE National and
State:
Veterans Association
GaHIN
(Emory, Grady,
CHOA, NE GA Health
System, GRITS)
eHealth exchange
Palmetto Health System
–
Columbia, SC
Department of Defense
(onboarding)
Social Security
Administration
(onboarding)
10
CHL/GRAChIE: Adding Value through
Connectivity in Chatham County
• Jail
• Behavioral health
• Indigent care
• Early Childhood Intervention
• HIV+
• Street medicine clinics
If we could provide continuity of care for these populations, it could in the
long run reduce homelessness and incarceration and reduce chronic health
issues for our lower income and most vulnerable populations.
11
Chatham County Detention Center
(CCDC)
Connecting the County Jail to CHL/GRAChIE and Building
a Continuity of Care
12
• 18,000 inmates per year
– 45% are treated for chronic illness (Source: CCDC)
– 90% of the inmate population is uninsured
(Source: Kaiser Family Foundation kff.org)
– Limited access to primary or behavioral health care; CCDC
may be their only access to health services. Georgia is a
non-Medicaid expansion state
– Complex healthcare needs. Untreated mental health,
substance use disorders, infectious diseases and other
chronic conditions are prevalent
– Deaths
– Focus on short-term stabilization
Health Care at the CCDC
13
• Chatham County
– New County Manager in 2015, recognized jail as a critical
piece of health care safety net. County funds indigent care
– CCDC sought to improve safety for both inmates and staff.
And reduce exposure to liability
– County fully committed to long-term financial support
– Support of newly-elected County Sheriff
• Community health care providers
– Inmates prior to and after incarceration use regional safety net
health care providers
• Safety Net and GRAChIE provided technical support
– Use of outside experts
Project Readiness & Political Will
14
• Convert paper medical records at CCDC to electronic medical
records (EMR)
– Repurposed EMR license (GE Centricity) from a local
Federally-Qualified Health Center (FQHC) for a total cost of
$300,000, saving the County $2.5 million
• Implement reliable way to identify patients and make sure
access to one longitudinal record (fingerprinting)
• Formulate performance metrics and system of accountability in
contract for health care provider
• Train CCDC staff and health care providers on process
Process to Onboarding
15
• As of October 2018, Memorial Health University Medical Center
recorded 11,168* patients that had been processed through the
CCDC
– Patient crossovers account for 62.0% of the average yearly
detainee population (based on 18,000 yearly census)
• FQHCs, Curtis V. Cooper Primary Health Care and J.C. are newer
connections to the HIE. As of May 2018, they share 2,698
patients or 17% of detainee population. FQHCs are more likely to
become a “medical home” for patients
* Patient count in HIE is cumulative
Continuity of Care – Crossover data
16
Accountability Structure:
• All detainees at booking must be queried in HIE to see medical
history. No ability to miss critical medical information or change
paper records
• Maintain minimum staffing levels of qualified medical personnel or
face financial penalties
Performance Measure:
• Maintain accreditation in order to demonstrate ability to meet
regulatory requirements and standards
Health Care Provider Accountability
17
Key factors to initiate a project to onboard a jail:
1. Assess project readiness with local safety net primary and
mental health providers as well as the political will among
elected officials
2. Find subject area experts/consultants that can help design a
process to onboard a county jail to a local HIE and help work
through barriers
3. Write a contract that has a meaningful accountability structure
with performance measurements that ensure accountability for
all parties to increase safety for staff and inmates and decrease
liability for local governments
Recommendations
